Photo © Paolo Patruno

VIDEO: Childbirth in the Shadow of the American Dream

The voices of African American women are key to resolving gaping maternal health disparities in the United States. Their voices are at the center of a new documentary by Italian filmmaker Paolo Patruno.

Birth is a dream. Or at least, that’s what Paolo Patruno believed before a midwife opened his eyes to the darker realities many women face in childbirth. Paolo is a World Pulse community member from Italy and an engineer, photographer, and filmmaker. As he traveled throughout Africa for work, women began sharing with him their harrowing journeys to motherhood.

Moved by what he heard, Paolo launched Birth is a Dream, a multimedia project to document their stories. This project has taken him to Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Morocco, Mozambique, Uganda, and Zimbabwe—and now, Orlando, Florida. His latest documentary is filmed in the United States, where African American women are nearly four times more likely to die from pregnancy-related complications than white women.

Watch the video to hear the story of midwife Jennie Joseph and a group of African American moms as they navigate the challenges and inequities in the US medical system. Then, go behind the scenes with Paolo Patruno in a Q&A with the filmmaker.


How did The American Dream documentary come about?

The American Dream is the latest story that I have produced for my Birth is a Dream project, which I began in 2011. After more than five years documenting maternal health in Africa, I started hearing from women all over the world, some of them from the US. As I started researching, I realized that women in the US face more maternal health challenges than other industrialized countries and black women are the most in danger. I realized this would be a good opportunity to show that this challenge is not just happening in Africa. More than 800 women are dying every day from pregnancy or childbirth complications all over the world. This is a silent war. Women are dying but it’s not covered by major media.

You are an example of how men can be involved in maternal health advocacy. Where did your interest in maternal health issues begin?

I met an English midwife while I was living in Malawi and working as an engineer. She was working in the main hospital in the capital Lilongwe, and she started sharing with me the challenges behind maternal health there and something happened in my mind. I had been traveling in Africa for many years and I didn’t know anything about this issue. That was the starting point. And story after story, year after year, my commitment and interest has grown.

I realized that maternal health is really such a complex matter. It’s completely different from any other health issue. It’s more of a cultural issue. The solution is not just coming through a medical approach. If you are an organization trying to solve a problem, it’s easier to say, “Oh this is the food for you, this is your drug, this is the pump for getting water.” It’s much more difficult if you need to go deeper into the behaviors behind the problems.

Has it been difficult getting your message out?

Trying to talk about maternal health is really a challenge, especially in the US. It’s much easier to say there is a problem over there. It’s not related to our society, to our communities. It’s easier to say, “You have a problem, sorry for that. But we are okay.” 

Birth is a Dream started as a way to give back to the African people. For more than 10 years I’ve been traveling in Africa for work, and I’ve received a lot. I wanted to use my skill, I wanted to use my commitment to open people’s eyes to what is happening in Africa. What I’m doing now with this documentary in the US is very similar. It is a personal project. It’s just a way to open people’s eyes.

I self-finance all my projects. I worked on The American Dream for four months and as soon as the film was finished, I wanted to make it public, to make it accessible for everybody. This is my idea of distribution. Just put it online, just share it on social media. You need to involve the main part of the society in the issue. For example, it is so clear that you can’t improve maternal health if that is only a women’s issue. You also need men to be aware about the issue.

For The American Dream you interviewed many women with different experiences. What is the connecting thread in their experiences?

Hearing these stories from black women when I was making the edit really shocked me. When I’m shooting video, for example inside a hospital, the suffering affects me. But I can go ahead because most of the time I’m focused in the moment on the technical work.

It’s when I’m editing that I can feel the emotions. I have three kids and I remember each of their births as a joyful moment for my family. Hearing that for many of these women it was not like that surprised me and made me sad. Instead of being a magical moment, for some of them giving birth is a sad memory; it’s a bad experience. I know they could have a different option. They should have a different option.

I realized as I was editing this film that just like the women I interviewed in Africa, the medical or health part of their stories is not the main issue. For example, in the US, for black women, it’s very clearly a race issue. They are all talking about experiences in hospitals where they felt powerless.

Each of them was maybe telling the story from a different angle, but they are telling the same story. I included all of the women in the documentary who I contacted and who agreed to be interviewed. They are all talking about the same issues that women of color are facing.

Over the years, I have had opportunities to attend many births, visit so many health facilities. Many times I’ve heard women say, “When we start laboring, we don’t know if we are going to survive or not.” They are overwhelmed by their worries and they are feeling powerless. In the US, reasons behind this may be different, but that feeling of powerlessness is the same. The black women I spoke to talked about being treated in a different way by the medical system. There is a woman during the interview, for example, who says she felt like a chart, not like a human being.

For many women in the US, maternal health is also a business issue. A C-section in the US is $30,000. You can have a C-section in Italy for free. How is it possible? In Europe you can have midwives attending a delivery and in some states in the US, midwives are not even licensed to work. There is something wrong that is not a health issue. If the public system is not supporting the midwives, they are pushing women to deliver in the hospitals where there is money and where they want the money to go. When there are business interests, when people are getting money, it’s very difficult to solve the problem.

When you think about all of the women you met who opened up to you and shared their stories, what are your hopes?

It’s not easy to put your camera, something cold, in front of somebody who is sharing her own life. I go home overwhelmed by all the feelings of the people who have shared their experiences with me and that is something that is driving me during the edit. I don’t like voice over. I just want the emotion coming directly from the characters of the stories straight to the audience. I have been affected by their emotion. I am trying to get the audience to feel the same emotions that I had at the moment that I was with these women.

What can viewers of your documentary do to honor the voices and stories in this film?

Share and talk. For example, with social media, people can share experiences and events that are happening thousands of miles away and from that they can start talking, "Yes, this is something that happened to me," or "that is something that happened to a friend of mine," so what can we do to improve that? The only way you can change society is from the bottom—to share, to let our voice be heard.


Region North America
Topic Health
1Send Me Love


That is some very good work. Maternal heath is an issue that is very close to my heart. Seeing someone so passionate about it just swelled my heart.

Keep up the good work.

With best wishes,

Nusrat Ara 


Thank you so much Jane ! 

I don't feel a change maker, you women working in the field every day to support other women are the real heroes, the real change makers. I just use my camera to give these women a voice.

Have a look at more stories from Africa on my website:  And please share this video...


Watching the movie opened my eyes that maternal health is not only an African problem but a world wide issue. Healthcare has failed women and it is now a profit making scheme and as a result the less fortunate suffer.

I did not have a good experience with my first birth and was lucky to have my second child. However due to hospital negligent I cannot have more kids and it is sad that many women silently suffer during childbirth 

Thank you Paolo for the inspiration.



Truly incredible work.  Thank you for shining this light.  I am sharing and will continue to hold this conversation inwardly as I open to new ways of understanding and helping, and outwardly as we collaborate toward a better way for all women.  

Thank you Paolo,


Thanks Carrie ! safe maternal health is a human right, but women die every die from complications of pregnancy and childbirth, not only in Africa and developing countries, as I tried to highlight with my documentary in US.

So thanks for sharing this project and for continuing to hold the conversation !

Hi Paolo You are doing an amazing job. It is true that birth is just a dream because you can never tell what will go wrong. Having given birth normally to two beautiful girls, i know it is by Gods grace that both instances were happy. For most the end is a sad one and at times we cannot blame the midwives if the system doesnot support them. For most it is a job and they cannot attach emotion to it so many times they are ruthless because they want to handle as many patients in a day. The pain that you go through to bring a life into the world is unbelievable and you need that comfort which you can never get in the healthcare system. Thank you for sharing and i will soon share my experience of child birth. God bless you

Mrs. Anita Kiddu Muhanguzi

Executive Director and Co Founder

Sowing Seeds of Tumaini Skype: mrs_muhanguzi

Hi Anita, I've experienced and documented all what you said, in many African countries, and in Uganda as well. You can listen to what this woman from Kabale told me: 

"There isn’t any pregnancy that could be the same as the other,  but is only God who is upon us. It’s only God who helps us to deliver"

That is very sad ! This is the reason why I'm running my project from more than 5 years, and not stopped yet !

You can have a look at my stories from Uganda here: 

Thanks a lot for your blessing !

This such a powerful documentary and a great topic to focus on. Thank you for doing this.

Sherna Alexander Benjamin

"Whenever the human rights of one is violated the human rights of all are in jeopardy." - Sherna Alexander Benjamin